HomeMy WebLinkAbout20053049.tiff I••4;::i::':L()..)I:: INDIVIDUAL SEWAGE WAt::;1::. X):!:..'sF'(:lSr"i4... SYSTEM PERMIT !'!(:1.. ;:s `:"b:ti,:;5:
I?Ji:::i...X) COUNTY HEALTH DEPARTMENT NEW !;'I:::I::I'I
ENVIRONMENTAL HEALTH SE:=:RV:I:?::;t::: ::,
:I.::-4 16TH I••# !'{41::1•II.J4::. COURT, c iRt:::!:::I...#:::`r` CO90631
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JI,JI4r...#:r, I:{l::.ttill'•E#: T'T.. IYII::.1•RY1... ADDRESS 15377 WCR 18 PH (303)
0 FORT LUPTON CO S0621
>,A)Dl' :::;S`:3 ;:)1:: I::Yti(11''(1Si:::):) SYSTEM :1.::x=.:.7'.7 i1Jr;l:ti 18
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/` / FORT 1 L..(JI^'T Ohl CO {:��yt?d::1.
(••(3(.L. DESCRIPTION:I:P T•:l:ON OF ;:y.l.'T I::.ii E::..,' i:JW4.J <3E:(, 22T WP Ay i•<I•I(., L.••L.t
;t.11:t1():t I S I:t:lN^ LOT 0 BLOCK 0 FILING 0
Jf)I : TYPE:; R1::::7:i'.I)i:::It#'r':1:61I... MOBILE I'•I(11"EE
at: RV:1:C:E S,. I'I::.. :;:3(14'•I;:t (y BATHROOMS :x:'...00 LOT SIZE 40.00 ACRES
BEDROOMS S :'. BASEMENT PLUMBING:t:i i(: NO Wr^,'rl:::R SUPPLY PWI:::#...t...
'If'P4...:#:(::A"I':i.c••.E FEE $1 50,00
:I:::(:' ':1) BY 1'i(11: 4:;:1:':S(:)i'#..!...k1RRi't:t:!'.M::: SIGNED B•Y #"4i:::#::l::c(I... :L:<I.::#`dN'•II:T;''
DATE I::. 02/07/94 DATE. 02/07/9
:'4:::1: ..04...••,•. .,.i:Jh# !,ATE .�..`'1... MIN PER. INCH LIMITING ZONE!':. ............ :..:::..... .
:;o:1:4... TYPE I'I:::i::(:;I:::N'r GROUND ::>I...(11::'4::: I):CRt:::C'r:1:!::r!'••4 K1_
EOUTRES ENGINEER DESIGN IN 100 YEAR FLOOD PLAIN )#`•,;::. ilip
..i:..;t:ii . THE ;"',PI:-•...:E:(:'r'a.r'.1.(:)Iy1 INFORMATION Ir1•T'::(11'•! SUPPLIED AND THE t14',!.•• >:1:'I'i::: <::;0.,.!... PakCOLATION DA.
r'1••iE I.:'I:::tt...t..-CJ1.'J:I:;.I1 MINIMUM INSTALLATION SPECIFICATIONS "•ii:.l: ',•';I:::(:1k.IRI:::t)::
`:::4:::PT':'r:(v fANK 1.;0..(20 (:AL...I...(:JI'•I`:, i`sTaSCAt'''T- :t:IN TRENCH PO ':: S::e.r FT. .
........` ABSORPTION u BED ,58'0. !:30.... ET •-
IN' . DITION, THIS S t 'I:::Rt'' 1 i {'#'''. ':'t..:P:.il:::(:;'T• TO THE FOLLOWING ADDITIONAL TERMS S AN r)
...O''1I).i: T :I:(11.4≤:>,: &a 1 ,eketl Dr ../..-,rr...1)•.S:....... . :.. ....... ..
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'MIS PERMIT :I.::> GRANTED TEMPORARILY TO ALLOW (::(:71•.I�; �T�I��k.�r.:"I-:I:#:;ICI TOt: t: !}'IIYIt:::t':4(::I:::.. • t 4:4:: P4:::RM:t:..r.
MAY x:i#:.: REVOKED (11': .::;t.J£:?#':'1:::NI)lE:I) T:{1' 'rl••II: WI:::L..I) COUNTY HEALTH DEPARTMENT I::'t1R REASONS '::!E:
FORTH ..N THE WELD COUNTY"'. INDIVIDUAL SEWAGE .()..SP(.JSr•sl... SYSTEM S, :::.1'r REGULATIONS :t:l'••((: 1...1.J:( :!:l'•-s(:I
FAILURE±:l...l.Jl:;#::: '1(1 MEET ANY TERM OR CONDITION IMPOSED THEREON DURING II TEMPORARY t:Y (:14; #:':I:Nn...
APPROVAL. '-I-I•'IF.:: ISSUANCE il''•I(: E (11::' THIS PERMIT T• I)(::'E:,:: 4''i(:)1 (:::(:il'••I'•:J1 I. rk.J..#l: ASSUMPTION T:;`,. ..#.I..14:::
DEPARTMENT OR ITS EMPLOYEES .)1� LIABILITY '" .I J#:;4::: :'s'I: l:I'ar"i:�:?I::(:II..Jr=',(:;Y OF 71••11:::I::: :� (' #::'�..JI:�; THE
::�EWr C :: D.T..,.., .!.., SYSTEM. *17/. El '41::: (.!I'tit`'IE:: .t',.... ...:#.r•,I...:l:`:;.1.. DT E.
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• ..::; PERMIT IS NOT T TRANSFERABLE AI'•I:t) <:;i••1,1i...4... Bl:::(. (--rl'•IE:.. {J(:J:!.x. ..r• SYSTEM ...:::il��#t,. i 4�:r..!(.. :i.'.::4:•. ,.!;::I':
� r':r
;AOT COMMENCED ITHIN ONE `!::.A S ISSUANCE. BEFOR ISSUING f: ...1•tblf.-. APPROVAL O!::
THIS PERMIT THE ':;1:::4...I) COUNTY HIE:AI...T•H DEPARTMENT RESERVES '?4•.EI::: R:I:(.f..i'r TO IMPOSE ADDI—
TIONAL i"1... TERMS AND CONDITIONS II):1:•T3:(1!'•1S !:+:f::(:!I.J:1:RI I) T•(:) MEET (1k.11:1 REGULATIONS ON ''s CONTINUING BA—
SIS. !::':!:4''•Ir'a4... PERMIT APPROVAL :I::. CONTINGENT UPON THE FINAL INSPECTION (11:' THE COM—
PLETED
4 I
SYSTEM BY THE WELD (:.(1k.1h4T"i rlc::AI...'T'I••I DEPARTMENT.
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2005-3049
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or:...i.n.ff.It•::E ....4:IiN:''1 TrANTh r'i1I::.•Y....W(::I••II) • W(::f••II)....E:1••I£; MAY . 1
r. ``y'
Fdfat::::.;)fiaF: INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMITT.. ':;4;'ar,.5.
t+Jr::i...Y} (:'(:1(.11•-!T'Y I••11:::i'',I...Tl.•1 Y}E::!'.(.1:;:T'MYI1:::N1' NEW E:'1"I::;Y1:1;
A0".. ENVIRONMENTAL i-.ii:ihs1...1!•.I '•: I:::R'•✓':l:f:::3::: :S
t).:;
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:!.,+:!, :1.6 T#•'I AVENUEAVENUEi.(.�t.COURT, (:1l'il:::!:::l...i:::'`r ., CO 00631
:)t,J1'4I::r� l:{!:::htl•*iE:T"i' IYIR:i:�I:"tYt.. � ADDRESS 15377 W(::F :1.':i ':'' t .�t:i.. .) 257• .......
E,
• FORT 1...t.JF:'T'C)h•l CO S0621
`,I}I}r{:E:::2:S :S (.11::• PROPOSED SYSTEM M 15377 W(1R 18
FORT t.J,:. r IN CO S0621
..E::(:,N... Y)ES(::1:'::I.l::.1 :l:(:NCI OF s.3:EtE :: E:< :SW4 #3t::(:; x:'.2 TW!"' x RHO 66
::1.f:(:D I:'•.1:I S I:k.)N: I...crr t} BLOCK () FILING 0
.J::iE:: TYPE: RESIDENTIAL lY!(:)I:t:Ei..I:E HOME
:
3)::.k%J.I.(.:....:::;:, PERSONS 2 BATHROOMS .:.. ,...I..,...... 40.00 ACRES
BEDROOMS 2 BASEMENT#SIT PLUMBING NO WATER SUPPLY !:: JI:::L.I...
)I::•i::l...:t:i::A T-:1:(:N FEE 1;150,00 '
.,.x .(•:•:' , i ,•(•. , T: Rrs:1:1'=lE:: SIGNED
DATE 02/07/94 . DATE 02/07/94!
'r.ION RATE ,5+ ... ''t:l:!'.1 1:'"s:::l::;- .INCH LIMITING :'0NE>..
:S(:)II... TYPE LPERCENT GROUND SLOPE• ''
::l:i:(:Tt_I.1.1:.:::.::: .::.:tlt:.,.;.i,::.,::. : DESIGN ............... i
::F (:)i': THE APPLICATION :1:Nr'i:7F':1' ATI:(:)!`'! SUPPLIED AND THE ON—SITE :OIL 1 ' ' :'.::(.JI...F:t., :I:ON r:•'s::i'';:
Il••II::. FOLLOWING MINIMUM u INSTALLATION SPECIFICATIONS "I't ':i S '!.:::I)..
. �'.�, r I •••s•'I::: REQUIRED:
r•:SE::•.::.TT f;::,E-lK foot? (:3m...1...(:ms„ 0,I:si.)l::,.'. ''1:1::::ii'•! 't I:...I:::I••lt:`.1..! P.t.)_ '::i :i.: ET. .
ABSORPTION BED 0 ...::T.. ::'
.I: : .R:(..N.. T't•1:1:;:, PERMIT ;I: . • <••..•.:.:�I:::(::•"• TO THE 1:..(:)I...s �" .E:I•••1C:+ .,-•:?f:.1.1:1.'i 'i�'ii... :::l�'I''1;:: �''>sF:!:(;
CONDITIONS:: 6 eLAv) I/.....[5,0.5 15...., r1c OT/te of/p4.w................ ................. .......
THIS I.!::R,Y1:1:•'!• :::S GRANTED TEMPORARILY T•(:) ALLOW CONSTRUCTION i TO COMMENCE.IIYIF:i'••!(:;1:.. 'T'%'•I:#:c3 PERMIT
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MAY BE REVOKED (:)1:: SUSPENDED BY THE: WI;::I...I) COUNTY Y HEALTH DEPARTMENT FOR REASONS .::S!..:"
FORTH IN THE WELD '::;(:IU!'''#TY IND:l:V:Fnt.J(L. SEWAGE DISPOSAL I... SYSTEM REGULATIONS INCLUDING
FAILURE .i..(:1 MEET ANY TERM OR (::(: NI):i:'T':I:O!''! IMPOSED THEREON!: l:t:)I••I DURING TEMPORARY (:11:'; FINAL
:I''tw•1!...
APPROVAL. THE ISSUANCE OF TI•'IIS F:'E::l:i!`'!:1:'T' DOES t.ic)T CONSTITUTE ASSUMPTION k:'Y. THE
DEPARTMENT (:N:: ITS EMPLOYEES OF LIABILITY FOR THE. -Y — .1..1RE:: (:N:'. INADEQUACY t:11::' THE SEWAGE DISPOSAL SYSTEM. . ,. *30E::`
El J:f: •=a.i1�,11L. A— r•'::.•..:.i:rhsl.... , .:'r'i ,
THIS PERMIT .1.;:, ;..1(.;•T.. TRANSFERABLE AND z:31••!t"•,....:... Bl:::?:::.:.YIi::: VOID:I:.,. IF SYSTEM COs,t;::...sT.... HAS
1'•I(:)'T COMMENCED lE::l'i(:;I Y) WITHIN (:)t'•ll::: YEAR i�l:' ITS ISSUANCE. BEFORE ISSUING FINAL APPROVAL OF
THIS PERMIT 7I•'II::: WELD COUNTY HEALTH DEPARTMENT RESERVES T'i..II::: RIGHT I(:1 IMPOSE i:;):,Y'!:•••.
T:I:(::!4(h•,!... TERMS f11''•II) t:'C)I''II}:I:'I':1.c:'1I::S REQUIRED 1c lit:::!:::'T' OUP REGULATIONS (:NH! A CONTINUING BA—
SIS.::S:l:f:::.. 1: :I:I•Ir'A!... I::'I::I::h•E:1 1 APPROVAL IS CONTINGENT UPON THE ii:: FINAL INSPECTION (:)F'' THE (::(:13x!'...
I::'l...E::T-;:::I) `: `::;:S T-1:::!''1 BY THE WELD COUNTY HEALTH DEPARTMENT.
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1.1I:.•'1'1•F HAf:,i ...;::.E '+::•I 't' "6 NT i'`.i i!.:''r-•••l,Jc':;1--IY) W(:;t..11)....l:::I•:I 3 MAY... 1
07-13-01 OT:33AM FROM-DIVISION OF IIUSER RESOURCES 3038662223 T-688 P.06/07 F-381
Nn.fs•72 • COLORADO DIVISION OF WATER RESOURCES X�
101 Columbine Bide.,1845 Sharman St.,Denver,Colorado 80203
PERMIT APPLICATION FORM 7 //73
t ApliwtiQgn� must G
A complete where ��n/ (Xi A PERMIT TO USE GROUND WATER
applicable. Type or 'W .
, ()/1) A PERMIT TO CONSTRUCT A WELL
print in BLACK FOR: ()[) A PERMIT TO INSTALL A PUMP
INK.No overstrikes
or erasures unless 1 ) REPLACEMENT FOR NO .
initialed.
( )OTHER
(1) APPLICANT - mailing address FOR OFFICE USE ONLY: DO NOT WRITE IN THIS COLUMN
• t �
NAME w/ta� A t Mt t+. t Receipt No. yam-/ 1/7 /
STREET A o X 717 9asin Dist.
cm Po r k k t )1-0A ells to b if t ONPlT1ONS Of APPRQ![A►
TELEPHONE%NO. I rn - 2 1/Li This well shall be used In such a way as to cause
no material injury to existing water rights. The
(2) LOCATION _F fROPOSED WELL - issuanceof the permit does not assure the applicant
that no injury will occur to another vested water
19
right or preclude another owner of a vested water
county V� l/ right from seeking relief in a civil court action.
g 0 z of the $ kJ %,Section ;-e .- (1) APPROVED PURSUANT TO CRS 148-18-36 FOR
N_, Rng. 6 G (4 , b P.M. COMMERCIAL AND DOMESTIC PURPOSES. (2) AP-
PROVAL OF THIS PERMIT IS CONTINGENT ON THE
(3t WATER USE AND WELL DATA CANCELLATION OF PERMIT NO. 52840. WELL NO.
52840 MUST BE PLUGGED AND ABANDONED ACCORDING
--)'^ '� TO RULES AND REGULATIONS. (3) AVERAGE ANNUAL
raposed maximum pumping rate(gpm) / 4 APPROPRIATION LIMITED TO ONE (1) ACRE FOOT
Average annual amount of ground water ) FROM THE LARAM3E-FOX HILLS AQUIFER. (4) A
TOTALI217VG FLOW METER MUST AE INSTALLED ON
to be apprnurlated (acre-feet): /
WELL, RECORDS OF ANNUAL PUMPl:NC MUST BE
Number of acres to be irrigated; VI'0 vv-c. MAINTAINED AND SUBM71-1.t:u TO TICE DIVISION OF
/Proposed total depth (feet): �S0 WATER RESOURCES. nal 3/a1/7.3
`//Z1/7�S
Aquifer ground water is to be obtained fro : /_
1. Ar✓ir fit ttl --- Par- r` I
Owner's well.destgnation
QROUND WAI R TO RE USED FOR;
( I HOUSEHOLD USE ONLY-no irrigation (0)
( SIDOMESTIC (U ( 1 INDUSTRIAL (61
1 I LIVESTOCK (2) ( I IRRIGATION 16)
1t) COMMERCIAL (4) ( I MUNICIPAL CSI
( ) OTHER la), APPLICATION APPROVED
PERMIT NUMBER YA 017082 -f
(4) DRILLER A
I DATE ISSUED MAR 2 91973
Name III 11 A 4 i /L EXPIRATION DATE MAR 2 9 lg74
Street Q��, Qttiii e c I, ri p tilt D r�/ ay,. .
^ ity . -1!5#'4 �ts
1 q¢1Q 6, ji Ie6 0 T INEE
x'24 yig
Telephone No. Lic, Na. 7 5
9
I.O. / COUNTY 6=-
07-13-01 07:33AM FROM-DIVISION OF $A ER RESOURCES 3038662223 1488 P.07/07 F-381
' (5) THE LOCATION OF THE PROPOSED WELL and the area on (6) THE WELL MUST fil5 LOCATED BELOW
which the water will be used must be indicated on Thu diagram below. b distances from section lines .,
Use the CENTER SECTION (1 section, 640 acres,for the well location. ! _ _
t - 1- ' H- - -f- - -I-- - -1- -- -I- - H" - + n. from $(norwor touch) SyC. tine
I CI— -7 MILE.5780 FEET— I " f[. from W4 ft sec. line
(alit or waatl
t -4- + t -t- -( •j^ ±
LOT BLOCK FILING •
I I I
+ - -I• - NORTH SECTION LINE _ t - SUBDIVISION
(7) TRACT ON WHICH WELL WILL @t
NORTH I,OcATED
'{' + i" - H.... -- '- — 'f 't No. Of acres / Will thiz be
n
I
▪ t
m I the only well on this tract? y.eJ
G ri -4- - +
' H I I g (B) PROPOSED CASING PROGRAM
[ I Plaip eine
f
LPG/ C- in.from 0 ft. to Sr° ft.
I I lc I
II in.from ft.lo_ ft.
— ± ' SOUTH EEO-HON LINE — T — "�' ��r'Tad dHSing 4- a O
i+ " in. from _ft. to ft.
+ t ± 4 -i- + t in. from ft. to ft.
I I I I (9) FOR REPLACEMENT WELLS give distance
4II ��L�� Iand direction from old well and plans for plugging
- - + - -F- - T - t - -1- - -I- - -+- - T it:
t
The scale of the diagram is 2 inches= 1 mile
e'... Each sm'al I square represents 40 acres. i
WATER EQUIVALENTS TABLE IRoundeo Figures)
An acro-foot covert 1 ecru of rune 1 foot deco
1 cubic fool persocand (chi) . . .449 gallons per minute(gpm) '
A family of 5 will facture approximately 1 acre'foor of water per year.
1 etre`foot .. .43,060 conic Iael...525,900 gallons,
1.000 eprn n, mpaa continuously for ono day practices 4.42 acre-foot.
(10) DONWHICH ROUND {1TEEB WILL BE USjD: 1/
Ownerls,lf✓r'1 4 1'►(+tte it 0/1�+ �,.I se‘0 a `YL l ig-. ^ No. of acres: 7 0
Legal description: Knit�,4Jnm/I bb�l/ c 1�.- tI&I�!-call a to a.DO Graf Hi w '-t
(11) DETAILED DESCRIPTION of tt se or ono d water: 7 f
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(12) OTHER WATER RIGHTS used on this land, including wells.
Type or right Used for(purpose) Description of land on which used
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(13) THE APPLICANT(S) STATE(S) THAT THE INFORMATION SET FORTH HEREON IS
TRUE TO THE BEST OF HIS KNOWLEDGE.
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SIGNATURE OF 4PPL(CAHr1SI
r
Use additional sheets of paper if more space is required.
07-13-01 07:32AM FROµ-DIVISION OF .WAZER RESOURCES 3038662223 T-688 P 03/07 F-381
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C0LORAP0 WATER WELL AND PUMP INSTALLATION CONTRACTORS WELL
PUMP INSTALLATION REPORT PERMIT
ND. O / 7d �'✓
OWNER'S NAME DATE
7 - (. � 0/I-e-/'-
DwNtk S ADDRESS
4' 2
1 22c4 t-" S-" CPO& •1
PUMm P� M `AFE sI YPE POWERI`PP BY HP
R[1ASE�'CiN .CLT DEPTH StY ' PIPE E
/ ,220 h/ a � / / ,
WIRE SIZE SHAFT SIZE IMPELLER SIZE NLMBER OF BOWLS
Y- 3
G.P.M. DELIvERED AT OPEN DISCHARGE TANK SIZE ORAwDOWW
/z /..-20 jots:.
/.
PUMP INSTALLER'S SIGNATURE LICENSE EN$G NUMSCR
.J/. r
REMARKS:
WRL-9-6B
07-13-01 07:33AM FROM-DIVISION OF }PATER RESOURCES 3038662223 T-688 P.05/07 F-381
PUMP INSTALLATION REPt. f • - , -
'um Make t) ^ 7 A'7'
P • •: III -/-404/ a �1;\
pe ------ -- - _t "oar ��
• A -' !.‘s A •
'owered by HP Sc
Lee .
'ump Serial No. y -' V
c: . ., S...., WATER
vlotor Serial No, — , i O14 TABLE
W pal
)ate Installed a
U'
• n W
'Lamp Intake Depth ._ __________ ____ . _._ _. • • F t! .
-- -- -- iJ . -3C - _i
iemarks c" ' o
a # -
ra ar 3 ,
a. TIC
W %, '•
. 1 I.
' : t a • T
MELL TEST DATA WITH PERMANENT PUMP t1 ;
)ate Tested 1 x t:ON E of
i- a- DEPRESSION
itatic Water Level Prior to Test ._. _ . h w ,Y
_ength of Test Hours •
AT
^stained yield (Metered........_._ _—.___ GPM •
$i
'umping Water Level _ : .'
Remarks l-'1
• c::e.
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CONTRACTORS STATEMENT
The undersigned, being duly sworn upon oath,deposes and says that he is the contractor of the well or
pump installation described here that he has read the statement made hereon; knows the content
thereof, and that the safne is t e f his own wle
SigCaaEure_ �NyG _'t. License No.
4.tate•of coloredv; County of _ oanr-i-e-'1.-/ SS
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Subscribed and iwtan to before me this /+rday of , 1970.
My Commission capital Apr. 10,1976
My Commissi reexpires: op , 19 _ .
Notary Public C � . .
FORM TO BE MADE OUT IN QUADRUPLICATE: WHITE FORM must ba an original coov on both sides and taped.
WHITE AND GREEN copies must be tied with me State Engineer.PINK COPY is for the Owner and YELLOW COPY 14 10/No Drium.
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